The Federal Office of Personnel Management (OPM) contracts with health plans throughout the United States providing medical and dental coverage for federal employees and their families. Use of Blue Cross and/or Blue Shield provider networks gives eligible FEP members world-wide access to Participating and Preferred providers.
Claims are processed according to the benefits, rules, guidelines and regulations of the federal government, which supersede state laws. Blue Cross and/or Blue Shield Plans offer two coverage options: Basic and Standard.
All FEP member numbers start with the letter "R", followed by eight numerical digits. Note: On the provider remittance advice, that member number shows as an "8" rather than "R".
The enrollment code on member ID cards indicates the coverage type. View sample member ID cards.
Both the Basic and Standard Option Plans require that some services and supplies be pre-authorized. View the Federal Employee Program Medical Pre-Authorization List.
Claims and contact information
Claims for members 65 and older are subject to Medicare pricing.
Prior Plan approval must be obtained for certain services. The pre-service claim approval processes for inpatient hospital admissions (called pre-certification) and for other services (called prior approval), are detailed in the online FEP Benefit Plan Brochure. A pre-service claim is any claim, in whole or in part, that requires approval from us before members receive medical care or services. In other words, a pre-service claim for benefits (1) requires precertification or prior approval and (2) will result in a reduction of benefits if pre-certification or prior approval is not obtained.
Timely claims filing guidelines
- Participating and Preferred providers: Claims must be submitted within one year from the date of service. Note: If the local Blue Plan's provider contract includes a timely filing provision that is less than FEP's, the local Plan will follow that guideline.
- Non-participating providers and members: Claims must be submitted no later than December 31 of the calendar year after the year in which the service was rendered (e.g., If the date of service is April 30, 2016, the claim must be submitted by December 31, 2017).
Correspondence - Disputed claims - Medical records requests
If you receive a request for medical records, they can be submitted via the options listed below. Note: The fax option is exclusively for medical records/chart notes that have been requested by FEP (via post claim review). Please continue to utilize appropriate methods for correspondence that has not been requested.
- Fax: 1 (888) 875-6921
- Email via RightFax
When submitting medical records via RightFax, the following information should be included:
- R number
- Patient name
- Claim number
- State (WA, OR, UT, ID) where services were rendered
- Indicate whether the claim is professional or facility
- Provider contact information
Coordination of benefits
FEP members may only have benefits under one FEP plan; however:
- They may have benefits under a non-FEP plan, in addition to their FEP coverage.
- If Regence FEP is not the primary insurer, submit claims to the primary insurer first.
- Please include primary payment information when submitting paper or electronic claims to Regence FEP for secondary payment.
If the rendering provider disagrees with the payment determination on a particular claim, he or she may request reconsideration. If the claim was denied as a provider write-off, the provider may appeal the decision. Learn more about the Appeals process. Appeals for FEP claims may be submitted to:
P.O. Box 1388
Lewiston, ID 83501-1388
If the claim was denied as member responsibility, the member may request reconsideration as outlined in their Blue Cross and Blue Shield Service Benefit Plan brochure (federal benefits brochure).
- If the member is still dissatisfied with the outcome, he or she may submit a written appeal to the OPM.
- Parties acting as a representative for the member, such as medical providers, must include a copy of the member's specific written consent with the review request.
- This procedure is outlined in detail in the federal benefits brochure.
Contact FEP Provider Customer Service.
Health and wellness
Learn about FEP's Hypertension Management Program and their focus on blood pressure monitor benefit and procedures. Share these informational flyers with your FEP patients:
- Clinical competency: Self-measured blood pressure monitoring at home (PDF)
- Measure accurately and promote self-measured blood pressure monitoring at home (PDF)
- Self-measured blood pressure monitoring at home How to check a home blood pressure monitor for accuracy (PDF)